PANS/PANDAS
Could My Child Have PANS or PANDAS?
Understanding the Overlooked Medical Roots of Sudden-Onset OCD, Tics, Rage, and Anxiety
You are not imagining things.
If your child changed overnight – suddenly battling severe anxiety, rage episodes, intrusive thoughts, tics, obsessive behaviors, or even food refusal – you may be facing something deeper than “just a phase.”
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are immune-mediated neurological disorders. They arise when the immune system, instead of just fighting an infection, turns on the brain, triggering profound shifts in mood, behavior, and cognitive function.
These children do not need stricter parenting or a new therapist. They need medical investigation, immune support, and nervous system repair.
What Are PANS and PANDAS?
PANDAS is a specific diagnosis describing a sudden onset of OCD or tics triggered by a strep infection.
PANS is a broader syndrome that includes acute neuropsychiatric changes following a variety of infectious, inflammatory, or environmental triggers (e.g. Lyme, Mycoplasma, mold, viruses, chemical exposures).
Both conditions involve immune dysregulation and neuroinflammation, often centered in the basal ganglia, the brain region responsible for motor control, emotional regulation, and habit formation.
What Parents Typically See
Symptoms often appear abruptly. Many families report they woke up to a completely different child.
The Hallmark Triad:
- Obsessive-Compulsive Behaviors (OCD): new, often irrational rituals; intrusive thoughts; repetitive questioning; excessive reassurance-seeking
- Tics or Tourette-like behaviors: motor or vocal tics, sometimes complex or self-injurious
Regressive or restrictive eating behaviors: sudden food aversions, fear of swallowing, dramatically reduced appetite
Other Common Symptoms:
Anxiety, Panic, and Emotional Lability
- New or severe separation anxiety
- School refusal, social withdrawal
- Panic with minor transitions or changes in plans
- Frequent emotional breakdowns or mood swings
Motor and Sensory Abnormalities
- Handwriting deterioration (dysgraphia)
- Clumsiness or slowed physical responses
- Light, sound, or clothing texture sensitivity
Regressive Behaviors
- Baby talk, clinginess, need for constant comfort
- Forgetting how to perform previously mastered tasks
Somatic Symptoms
- Bedwetting, urinary urgency, frequent urination
- Insomnia, night terrors, refusal to sleep alone
- Dilated pupils, “terror-stricken” expressions
Cognitive and Learning Difficulties
- Short-term memory loss
- Trouble focusing or “processing” thoughts
- Sudden drop in academic performance
These symptoms often wax and wane or intensify during flares. If untreated, the condition can become chronic and deeply impairing.
What Causes PANS/PANDAS?
Common Triggers Include:
- Group A Streptococcal infections (strep throat, scarlet fever, peri-anal strep)
- Mycoplasma pneumoniae
- Viruses (EBV, influenza, SARS-CoV-2)
- Lyme disease and co-infections (Babesia, Bartonella)
- Mold/mycotoxins
- Heavy metals and environmental toxins
Why Doesn’t Every Child React This Way?
Because PANS/PANDAS reflects a perfect storm:
- Immune dysregulation (over-reactive or under-reactive immune system)
- Genetic vulnerability (autoimmune tendencies, detox impairments)
- Toxic or infectious burden
When the brain is caught in a prolonged cell danger response, the child becomes hypersensitive to physical, emotional, or chemical stress. Even safe things can feel like threats.
Diagnosing PANS/PANDAS
There is no single blood test for PANS. Diagnosis is clinical, based on sudden-onset neuropsychiatric symptoms and history.
PANDAS Diagnostic Criteria:
- Presence of OCD and/or tics
- Pre-pubertal onset
- Acute and relapsing-remitting course
- Neurological abnormalities (choreiform movements)
- Temporal relation to strep infection (patient may NOT have strep symptoms)
PANS Diagnostic Criteria:
- Abrupt onset of OCD and/or eating restrictions
- Two or more of the following:
- Anxiety (esp. separation anxiety)
- Emotional lability or depression
- Irritability, aggression, or oppositional behavior
- Regression in behavior or development
- Decline in school performance
- Motor/sensory abnormalities
- Sleep issues, urinary frequency, or other somatic signs
Our Approach to PANS/PANDAS
1. Identify and Treat the Trigger
- Targeting the infection (e.g., Strep, Mycoplasma, Lyme, Bartonella, SARS-COV 2, Influenza, and others)
- Clearing environmental sources of mold or toxins
2. Modulate the Immune System
Reduce Inflammation
- NSAIDs, corticosteroids
- Curcumin, resveratrol, omega-3s, quercetin, black seed oil and other natural agents
Modulate Immune Response
- Low-dose naltrexone (LDN) or Peptides (KPV, Thymogen Alpha)
- Intravenous immunoglobulin (IVIG)
- Therapeutic plasmapheresis (for severe cases)
Restore Immune Function and Diminish Autoimmune Tendencies
- Heal the gut, restore microbial balance
- Mitochondrial repair and nutrient repletion
- Removing mold, metals, and chronic immune triggers
3. Repair the Nervous System
Neuro-Nutrient Therapy for Neurotransmitter and Nervous System Imbalances
- NAC, Inositol, 5-HTP, Zinc, B6, magnesium, methylation support, lithium orotate, herbal adaptogens (saffron, lemon balm, passionflower)
Support Vagal Tone and Limbic System
- Trauma-informed therapy and somatic supports
- Breath work, polyvagal exercises, safe nervous system environments
What Recovery Looks Like
Healing takes time, but it is possible. With each flare that is properly managed, your child gains resilience. Many families see their children return to baseline and regain their joy, function, and confidence.
The earlier the intervention, the better the outcome.
You don’t need to wait until it gets worse. And you don’t have to navigate this alone.
PANS Treatment Model
Hi, I’m Dr. Ari Calhoun, a perinatal and pediatric Naturopathic Doctor and mother of two. Upon becoming a mother, I realized just how susceptible our children’s brains are to environmental factors, including toxins, microbiome alterations, immune activation, nutrient imbalances, and more. More than that, I realized how much heartbreak and stress brain based disorders can cause for both the child and family. Since then, I’ve been on a mission to identify, prevent, and heal the underlying causes of neurodevelopment and mental health disorders in our children.
What Other Parents Are Saying
“We have our Reesie back.” — Whitney
My daughter had hyperactivity, rage, vocal tics, and completely changed overnight. Dr. Calhoun was the first doctor who recognized it as PANS. Within 10 days of starting treatment, the rage and violence had stopped. Now she’s back in school, playing lacrosse, and doing sleepovers. Dr. Calhoun gave us our family back.
“Showers went from 8 hours to 30 minutes.” — Carrie
My child had contamination OCD so severe they didn’t leave their room and spent hours in the shower. With Dr. Calhoun’s support and supplement plan, we began behavioral therapy that finally worked. My child can now go to school, use a public restroom, and talks about their future again. We haven’t had suicidal talk or dissociation in over a year.
“Within 2 weeks, the tics stopped.” — Shalane
Our son had constant motor tics, meltdowns, and food rigidity. Within two weeks of starting Dr. Calhoun’s plan, the tics resolved, he was eating better, and leaving the park without meltdowns. It was a night and day transformation.
Ready to help your child restore a state of peace and calm?
You shouldn’t have to walk this journey alone.
We believe health care should be comprehensive, individualized, and collaborative!
Need Some Calm Support in the Meantime?
While these won’t always address the root cause. Sometimes we just need to take the edge off and decrease the severity of symptoms.